Failure to Notify Residents and Representatives of Hospital Transfers
Penalty
Summary
The facility failed to provide written notification to residents and their representatives regarding transfers to the hospital and the reasons for hospitalization for six residents. Resident 9 experienced a large emesis and acute abdominal pain, leading to hospitalization for a urinary tract infection and small bowel obstruction. Resident 28 was transferred to the hospital and admitted with a heart attack. Resident 36 was hospitalized with a urinary tract infection, and Resident 37 was admitted with altered mental status. Resident 43 was sent to the hospital following a fall and complaints of left hip pain, and Resident 62 was admitted with status epilepticus. In all these cases, there was no documented evidence that written notices were provided to the residents' representatives. The Director of Nursing confirmed that the facility did not provide the required written notices to the residents and/or their representatives when the residents were transferred to the hospital. This failure to notify is a violation of the residents' rights as outlined in the facility's discharge policy and resident rights regulations. The lack of documentation and communication regarding the transfers and reasons for hospitalization represents a significant deficiency in the facility's compliance with regulatory requirements.
Plan Of Correction
1. Resident 9, 28, 36, 37, 43 and 62 were notified of transfer to out to hospital by phone; however, they were not notified in writing. 2. Facility reviewed regulation for notice of requirements before transfer/discharge of a resident. Facility put in place utilizing a form to meet the regulation to accompany the bed hold notice. Business Office Manager and Registered Nurse Supervisor's were educated on sending written notice of resident transfer/discharge to responsible party. 3. Social Service director or designee will complete audit to ensure written transfer/discharge notice is sent for hospital transfer weekly times two weeks and monthly times two months. 4. Results will be reviewed at the Quality Assurance Performance Improvement Meeting.